甘油三酯–葡萄糖体重指数与脓毒症相关性脑病预后的关系

The Relationship between Triglyceride-Glucose, Body Mass Index and the Prognosis of Sepsis-Associated Encephalopathy

摘要: 脓毒症相关性脑病(Sepsis-associated encephalopathy, SAE)是脓毒症患者常见的致死性并发症，其病理机制涉及神经炎症、血脑屏障破坏及代谢紊乱等多因素交互作用，但临床仍缺乏特异性诊断标志物和有效治疗策略。尽管代谢紊乱已被证实是SAE进展的关键调控因素，但TyG指数、BMI及其联合指标在SAE中的动态作用机制及临床预测价值尚未明确。本研究通过系统综述发现，TyG指数升高通过加剧炎症反应和氧化应激显著增加SAE严重程度及死亡风险，而BMI对SAE的调控呈现“肥胖悖论”——低BMI因营养不良和免疫缺陷增加术后SAE风险，而高BMI通过代谢储备发挥保护作用。进一步提出TyG-BMI联合指数可整合代谢异常与肥胖因素，在预测SAE中展现更高诊断效能，并构建基于代谢–炎症轴的干预模型，为SAE的早期预警和个体化治疗提供新靶点。

Abstract: Sepsis-associated encephalopathy (SAE) is a common fatal complication in patients with sepsis. Its pathological mechanism involves the interaction of many factors such as neuroinflammation, blood-brain barrier destruction and metabolic disorder, but there is still a lack of specific diagnostic markers and effective treatment strategies in clinic. Although metabolic disorder has been proved to be the key regulatory factor of SAE progress, the dynamic mechanism and clinical predictive value of TyG index, BMI and their combined indexes in SAE are not clear. Through systematic review, this study found that the increase of TyG index significantly increased the severity of SAE and the risk of death by aggravating inflammatory reaction and oxidative stress, while BMI’s regulation of SAE showed an “obesity paradox”—low BMI increased the risk of SAE after operation due to malnutrition and immunodeficiency, while high BMI played a protective role through metabolic reserve. Furthermore, the TyG-BMI joint index can integrate metabolic abnormality and obesity factors, show higher diagnostic efficiency in predicting SAE, and construct an intervention model based on metabolic-inflammatory axis, which provides a new target for early warning and individualized treatment of SAE.